Abstract
Background
Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) has been regarded as the standard treatment regimen for classical Hodgkin lymphoma. In recent years, ABVD-like regimens, which emerged due to shortages and the lung toxicity of bleomycin or the emergence of immune checkpoint inhibitors and antibody–drug conjugates, may be favorable, but have not yet been tested.
Methods
We compared the outcomes of ABVD with ABVD-like regimens, which include bleomycin was completely or partially omitted; meanwhile, etoposide or PD-1 inhibitors were added.
Results
5-Year progression-free survival (PFS) was higher for ABVD than ABVD-like regimens in young patients (82.1% vs. 67.0%, p = 0.029), patients with serum beta-2 microglobulin (β2-MG) ≥ 1.85 mg/L (75.8% vs. 57.6%, p = 0.046), and advanced-stage patients with IPS score 4–7(63.1%, 18.3%, p = 0.038). For elderly (60.5% vs.76.1%, p = 0.089), patients with β2-MG < 1.85 mg/L (83.1% vs 76.1%, p = 0.282), and advanced-stage patients with IPS score 0–3(84.6% vs. 81.3%, p = 0.476), 5-year PFS for ABVD did not differ from ABVD-like regimens. Elderly patients treated with bleomycin-free regimens showed a better survival trend compared with ABVD (99.3% vs. 61.3%, p = 0.270).
Conclusion
ABVD is superior to ABVD-like regimens in achieving PFS in young patients or patients with poor prognosis including high IPS score and β2-MG level. ABVD-like regimens are as effective as ABVD in elderly or low-risk patients including low IPS score and β2-MG level; elderly patients treated with bleomycin-free regimens exhibit a better survival trend compared with ABVD.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding
This study was supported in part by the National Natural Science Foundation of China (Grant No. 81700187) and Henan Medical Science and Technology Research Project (Grant No. 2021-KY-1173-082).
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by QW, JG, YL, YZ, XK, and WW. The first draft of the manuscript was written by QW, JG, HH, ZW, and SQ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This study was approved by the Ethics Committee of Scientific Research/Medicine Clinical Trial of The First Affiliated Hospital of Zhengzhou University (Approval No. 2022-KY-0869; Zhengzhou, China).
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Wen, Q., Ge, J., Lei, Y. et al. Real-world evidence of ABVD-like regimens compared with ABVD in classical Hodgkin lymphoma: a 10-year study from China. J Cancer Res Clin Oncol 149, 3989–4003 (2023). https://doi.org/10.1007/s00432-022-04321-6
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DOI: https://doi.org/10.1007/s00432-022-04321-6